Cladribine tablets in people with relapsing multiple sclerosis: A real-world multicentric study from southeast European MS centers

• Published in: Journal of neuroimmunology 2023-09, Vol.382, p.578164-578164, Article 578164
• Main Authors: Adamec, Ivan, Brecl Jakob, Gregor, Rajda, Cecilia, Drulović, Jelena, Radulović, Ljiljana, Bašić Kes, Vanja, Lazibat, Ines, Rimac, Julija, Cindrić, Igor, Gržinčić, Tihana, Abičić, Ana, Barun, Barbara, Gabelić, Tereza, Gomezelj, Sarah, Mesaroš, Šarlota, Pekmezović, Tatjana, Klivényi, Péter, Krbot Skorić, Magdalena, Habek, Mario
• Format: Article
• Language: English
• Subjects: Cladribine; Multiple sclerosis; Real-world data
• ISSN: 0165-5728; 1872-8421
• DOI: 10.1016/j.jneuroim.2023.578164

Cladribine is an oral disease-modifying drug authorized by the European Medicine Agency for the treatment of highly active relapsing multiple sclerosis (MS). To provide real-world evidence of cladribine's effectiveness and safety in people with MS (pwMS). A retrospective observational multi-center, multi-national study of pwMS who were started on cladribine tablets in ten centers from five European countries. We identified 320 pwMS treated with cladribine tablets. The most common comorbidities were arterial hypertension and depression. Three patients had resolved hepatitis B infection, while eight had positive Quantiferon test prior to cladribine commencement. There were six pwMS who had malignant diseases, but all were non-active. During year 1, 91.6% pwMS did not have EDSS worsening, 86.9% were relapse-free and 72.9% did not have MRI activity. During the second year, 90.2% did not experience EDSS worsening, 86.5% were relapse-free and 75.5% did not have MRI activity. NEDA-3 was present in 58.0% pwMS in year 1 and in 54.2% in year 2. In a multivariable logistic regression model age positively predicted NEDA-3 in year 1. The most common adverse events were infections and skin-related adverse events. Lymphopenia was noted in 54.7% of pwMS at month 2 and in 35.0% at month 6. Two pwMS had a newly discovered malignant disease, one breast cancer, and one melanoma, during the first year of treatment. Our real-world data on the effectiveness and safety of cladribine tablets are comparable to the pivotal study and other real-world data with no new safety signals. •More than half of people with MS who received cladribine tablets achieved NEDA-3 in years 1 and 2.•The most common adverse events were infections and skin-related adverse events.•Cladribine tablets were well tolerated, without new safety signals, even in patients with comorbidities like resolved hepatitis B infection, latent tuberculosis, or non-active malignant disease.